Elective TJA during pandemic linked with higher morbidity, mortality rates
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Morbidity and mortality among patients who underwent elective total hip and knee arthroplasty was significantly greater during the COVID-19 pandemic compared with the same time period the year before the pandemic, study results showed.
“COVID[-19]-positive patients had statistically significant higher rates of overall [emergency room] ER visits, pneumonia, readmission rates and mortality. We believe that the increased mortality and complications are both from direct and indirect consequences of the pandemic,” Megan M. Mizera, MD, said at the Orthopaedic Research Society Annual Meeting.
Mizera is a fourth-year resident at Montefiore Medical Center in Bronx, New York, which, with Queens, New York, were the two New York City boroughs affected most by the COVID-19 pandemic, she said.
For their retrospective, cohort study, Mizera and colleagues included 359 patients who underwent primary elective TKA or THA at Montefiore Medical Center from Dec. 1, 2019 to March 16, 2020, just before all elective procedures in the city were stopped. Researchers compared the 2020 cohort’s primary outcomes of 90-day mortality and medical complications to an historic control cohort of 410 patients who underwent elective primary TKA or THA at the same center during the same time period the previous year, called the 2019 cohort.
A chart review showed baseline characteristics were similar for both cohorts, Mizera said, however a table displayed during her presentation showed rates of diabetes mellitus were higher among the 2020 cohort than the 2019 cohort at 36.5% and 26.6%, respectively.
“The 2020 cohort had statistically significantly higher rates of overall pneumonia, readmission rate, [pulmonary embolism] PE and 90-day mortality when compared to historic controls. The 2020 cohort also had increased rates of [deep venous thrombosis] DVT [and] cardiac complication. However, [this was] not statistically significant,” Mizera said.
The two cohorts showed no differences in ER visits, based on results of the study.
The seven patients in the 2020 cohort who tested positive for COVID-19 had statistically significant higher rates of overall ER visits, pneumonia, readmission rates and mortality compared with the remainder of the 2020 cohort, Mizera said.
Based on the abstract, the 2020 cohort had a 2.55% rate of overall pneumonia vs. 0.51% for the 2019 cohort. Four deaths occurred in the 2020 cohort, one of which was in a patient diagnosed with COVID-19, according to the abstract.
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